Multilevel Posterior Cervical Laminectomy and Fusion

Cervical stenosis refers to narrowing of the spinal canal in the neck region. This narrowing place pressure over the spinal cord resulting in neck pain. Other symptoms include lack of coordination, loss of balance during walking, tingling in the arms and/or legs, and even loss of bowel and bladder control. Some of the spinal conditions that may compress the spinal cord and nerve roots include disc degeneration, bulging or herniated disc, spinal stenosis, and spondylosis. Occasionally, there may be multiple disc bulges at various levels and the ligaments may buckle into the spinal canal, causing spinal stenosis.

Posterior cervical laminectomy is often performed for multilevel spinal cord compression from cervical spinal stenosis to decompress the spinal cord and nerve roots in the cervical region of the spine.

In cervical laminectomy, the lamina and spinous process are removed to create more room for the spinal cord and take pressure off it. In patients with severe stenosis, laminectomy may need to be performed at three or more segments and a posterior longitudinal ligament (OPLL) resection may also be required for decompression. In such cases, a posterior approach is preferred over an anterior approach as it is generally technically easier to perform. With multilevel laminectomy alone, there is a post-operative risk of developing instability that may lead to pain and deformity. To prevent this, usually a posterior fusion is also performed along with multilevel posterior cervical laminectomy. Fusion at three or more levels from the front can be difficult. Therefore, the procedure will be accompanied by a posterior cervical fusion to support the vertebrae with a bone graft.

Procedure

In posterior cervical laminectomy, the surgery is performed through a 3 to 4-inch-long incision made in the midline of the back of the neck. After the muscles are elevated off of the lamina, the lamina along with the spinous process is removed as one piece with a high-speed burr creating more space for the spinal cord. Usually, local autograft bone harvested from the patient’s neck or bone from the iliac crest is then inserted into the empty space between the affected vertebrae to stimulate new bone growth. Instrumentation such as rods and screws are also placed into the spine to hold the vertebrae together during the healing process.

Risks and complications

All major surgical procedures are associated with some risks. The potential risks of multilevel posterior cervical laminectomy and fusion include infection, bleeding, risks of anesthesia, nerve injury, and fusion failure.

The results of the surgery may be variable in some people with more extensive disease.

Generally, most patients find improvement in their hand function and walking capabilities after the surgery.

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